Two recent cases involved the availability and use of electroconvulsive therapy (ECT), with different results. Since Arizona appeals courts have not ruled on the use of ECT, the different conclusions of these recent decisions may be instructive in analyzing the use of ECT in Arizona.

ECT is, as most clinicians know, one of the most reviled and misunderstood therapies available to modern psychiatric medicine. Although most lay people believe they have some familiarity with ECT, few know more than the impressions they gained from such depictions as One Flew Over the Cuckoo's Nest. While ECT is utilized as a treatment of last resort in most cases, it may be tremendously effective for dealing with some illnesses, particularly depression, after conventional drug therapy has failed.

ECT has been legally banned in some localities, and has been the subject of public demonstrations and intense political pressure in many jurisdictions. As administered today, however, the procedure is relatively safe and frequently offers relief where no other therapy is helpful.

In Illinois, Lucille Austwick admitted herself to a psychiatric unit specializing in geriatric patients. She was diagnosed as suffering from chronic depression and dementia. Physicians recommended that she be treated with ECT, insisting that her life was otherwise in danger. Her guardian (the Illinois equivalent of the Public Fiduciary's office) sought emergency court approval for the treatment.

The trial court hearing Ms. Austwick's case found that she lacked capacity, that there was no evidence whether she would have approved the ECT if she were able to communicate, and that the treatment was in her best interests. On review, the appellate court agreed that she lacked capacity and that the question should be whether the treatment was in her best interests. Citing the dangerous nature of ECT and specifically finding ambiguity in one physician's testimony, however, the appellate court found the trial court's decision "manifestly erroneous" and barred the ECT treatment. Austwick v. Legal Advocacy Service, Ill. App. Ct., 9/7/95).

In Wisconsin, meanwhile, in a case strikingly similar, the court reached the opposite conclusion. Ruth E.J. was severely depressed, and physicians told her guardian that ECT was the only hope for treating her depression. Wisconsin law dictates that ECT may be administered only with the patient's "express and informed consent," notwithstanding that Ruth E.J. was incompetent to give such consent.

Ms. E.J.'s guardian, like Ms. Austwick's, brought an action for court approval of the ECT. The Wisconsin court, however, reacted quite differently; finding that the statute as applied to Ms. E.J. was unconstitutional, the court ruled that ECT may not be withheld from a patient simply because they lack capacity to give specific consent. In re Guardianship of Ruth E.J. v. Ruth E.J., Wis. Ct. App., 9/6/95).